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At least 199 records · Page 11Linked to original sources
PubMed1991

Locked intramedullary fixation for metaphyseal malunion and nonunion.

Locked intramedullary rod fixation, established for metaphyseal fractures, is applicable to reconstructive procedures. Fourteen cases of complex nonunion or malunion (five infected) were reviewed retrospectively. Thirteen of the 14 fractures united. Eleven of 14 required an open procedure for removal of metal, soft-tissue release, bone grafting, osteotomy, or resection of infected bone. Infections were controlled by resection, depot antibiotics, and early stabilization. Interlocking intramedullary rods are an excellent fixation technique for posttraumatic metaphyseal reconstructive procedures.

Adolescent↗
PubMed1992

Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures.

Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopaedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0.13 mGy and to the dominant hand 2.10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made.

Femoral Fractures↗
PubMed1986

Treatment of tibial fractures by reaming and intramedullary nailing.

We treated 112 fractures of the tibia by manipulative reduction, reaming of the medullary canal, and fixation of the fracture fragments with an intramedullary nail. Seventy-six of the fractures were acute, and eight of these were second or third-degree open fractures. The other thirty-six fractures had a non-union, osteotomy for malunion, or failure of other types of treatment. Follow-up of 100 fractures showed union in all but one, which was in a drug abuser who had an amputation due to infection. The main complication was infection, which was successfully treated in six of seven fractures. The method of treatment, employing either closed or open technique and recently making use of interlocking bolts to stabilize one or both principal fracture fragments on the nail, is an excellent one for unstable acute fractures and for secondary procedures in fractures that are not associated with infection. The infection rate was increased with the open surgical technique. The few contraindications to its use are described.

Adolescent↗
PubMed1987

Expandable intramedullary device for treatment of fractures in the hand.

Because the hand tolerates disuse so poorly, the beginning of early motion following fractures is important in achieving early restoration of function. This report concerns the use of a unique, expandable intramedullary device for internal fixation of metacarpal or phalangeal shaft fractures that renders enough intrinsic stability that motion may be started early without fear of loss of reduction. The device is applicable for transverse or short oblique fractures and consists of a cylindrical apparatus made of titanium that allows for collapse in the circumferential diameter. It is introduced into the medullary canal in its collapsed state, and then is released to allow reexpansion into its normal diameter in the canal with the fracture reduced over it. This gives excellent fixation and affords stability approaching that of normal bone. Minimal postoperative immobilization is needed and early restoration of motion is possible. The device may also be used to immobilize metacarpal bones or phalanges following osteotomies, and it appears to be excellent for fixation of the bone in digits to be replanted. No complications have occurred in the reported series.

Finger Injuries↗
PubMed2005

Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation.

BACKGROUND: To compare closed intramedullary nailing with open plate and screw fixation and set the indications for each treatment modality in distal metaphyseal fractures of tibia, 64 consecutive cases of fractures that had been randomly treated with either method were prospectively followed up. METHOD: Thirty-four patients were in the group treated with closed intramedullary nailing (Group I) and 30 patients were treated with open reduction and internal fixation with anatomic plates and screws (Group II). They were observed for 2 years, and the end results were compared between the two groups. RESULTS: The duration of operation was 72 minutes in Group I and 89 minutes in Group II (p = 0.02). The period of time before radiologic union was 18 weeks in Group I and 20 weeks in Group II (p = 0.89). There was one superficial infection in Group I and six superficial infections and one deep infection in Group II (p = 0.03). The average angulation was 2.8 degrees in Group I and 0.9 degrees in Group II (p = 0.01). The ankle dorsiflexion at the final follow-up was 14 degrees in Group I and 7 degrees in Group II (p = 0.001). The Olerud and Molander functional ankle score was 88.5% of normal side in Group I and 88.2% in Group II (p = 0.71). CONCLUSION: Our results have shown that locked intramedullary nails have an advantage in the duration of operation, restoration of motion, and reduced wound problems, and anatomic plate and screws can restore alignment better than intramedullary nails. It can be concluded from this study that intramedullary nails are recommended for fractures associated with soft-tissue damage of Tscherne C2 or higher. In other cases, the authors think that either treatment modality can yield expected results.

Adolescent↗
PubMed2005

Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation.

BACKGROUND: Internal fixation of proximal humeral fractures is associated with a considerable secondary malalignment rate. Fixed-angle implants have been suggested to increase the stability of fixation. METHODS: The biomechanical properties of four different implants were tested. These included an internal fixator with semi-elastic properties (reference), the Synthes T-plate, a locked plate with rigid properties and a spiral blade locked intramedullary nail (PHN). These implants were assessed in twenty-four osteotomized pairs of human cadaveric humeri. Specimens were subjected to two-hundred cycles of axial loading and torque followed by load to failure. RESULTS: The PHN had greater axial stiffness than the reference and the T-plate. During torque, all implants were stiffer than the reference. During cyclic loading, there were no differences between the T-plate and the reference. Both the rigid internal fixator and the PHN had less irreversible deformation than the reference. Both implants resisted higher loads before failure. CONCLUSION: This study showed that the proximal humeral nail and the rigid internal fixator are stronger than the semi-elastic locked plate and the Synthes T-plate for unstable subcapital proximal humeral fractures.

Biomechanical Phenomena↗
PubMed1996

Hackethal nailing in closed transverse humeral shaft fractures after failed manipulation.

A study has been carried out of retrograde intramedullary fixation with flexible Hackethal nails for closed transverse fractures through the middle third of the humerus. Thirty fractures were treated during a period of 12 years. The average age of the patients was 45 years. After operation, a brace was used for an average of 4 1/2 months. Union occurred at an average of 10 weeks with one case of delayed union. There were no infections or nerve palsies. Hackethal nailing is effective for this type of fracture when manipulative reduction has failed.

Adult↗
PubMed2006

Long-term outcome of elastic stable intramedullary fixation (ESIF) of femoral fractures in children.

In 1993 a prospective data collection of all femoral fracture in children below 16 years of age was initiated in 4 hospitals in the Netherlands. Follow-up was at least two years, with the aim to evaluate leg length discrepancies (LLD). Over a period of 10 years, we included 136 patients < 16 years of age with femoral fractures. Seventy-one patients who were treated with an ESIF-(Elastic Stable Intramedullary Fixation) nail were studied: 44 boys and 27 girls, between the ages of 3-16 years, 23 of which had multiple injuries. Five patients had a Ist or IInd degree open fracture. The average length of stay (LOS) of children with an isolated fracture, was 10 days, and in case of multiple injuries: 12 days. Intra-operative complications were: a broken drill in 2 and an open reduction in 6 cases. Two patients with superficial wound infection were successfully treated with antibiotics. Seven patients had knee complaints of the nails, of which 3 had actually been displaced. Three other patients showed displacement of the nails at X-ray, but had no complaints. At six months follow-up, at the time of removal of the nails, 10 patients had a leg length discrepancy (LLD) exceeding 10 mm. Three children had a clinically significant rotational deformity at this time. Two and a half years after injury 6 patients showed a persistent LLD of more than 10 mm. In all 6 the fractured limb was longer. At ten years of follow-up the LLD persisted in 5 patients. One patient had a persistent clinically significant rotational deformity of more than 10 degrees . The advantages of ESIF-nails are: reduction of hospital stay and rapid mobilisation. The disadvantages: two operations (for insertion and removal) with a risk of complication. Long-term follow-up, preferably till growth stops, is necessary to conclude whether persistent lengthening of the fractured limb remains a problem.

Adolescent↗